Abstract

Background

There is little evidence to date of the potential impact of vegetable gardens on people
living with HIV (PLHIV), who often suffer from social and economic losses due to the
disease. From 2008 through 2011, Action Contre la Faim France (ACF) implemented a
project in Chipinge District, eastern Zimbabwe, providing low-input vegetable gardens
(LIGs) to households of PLHIV. Program partners included Médecins du Monde, which
provided medical support, and Zimbabwe's Agricultural Extension Service, which supported
vegetable cultivation. A survey conducted at the end of the program found LIG participants
to have higher Food Consumption Scores (FCS) and Household Dietary Diversity Scores
(HDDS) relative to comparator households of PLHIV receiving other support programs.
This study assessed the incremental cost-effectiveness of LIGs to improve FCS and
HDDS of PLHIV compared to other support programs.

Methods

This analysis used an activity-based cost model, and combined ACF accounting data
with estimates of partner and beneficiary costs derived using an ingredients approach
to build an estimate of total program resource use. A societal perspective was adopted
to encompass costs to beneficiary households, including their opportunity costs and
an estimate of their income earned from vegetable sales. Qualitative methods were
used to assess program benefits to beneficiary households. Effectiveness data was
taken from a previously-conducted survey.

Results

Providing LIGs to PLHIV cost an additional 8,299 EUR per household with adequate FCS
and 12,456 EUR per household with HDDS in the upper tertile, relative to comparator
households of PLHIV receiving other support programs. Beneficiaries cited multiple
tangible and intangible benefits from LIGs, and over 80% of gardens observed were
still functioning more than one year after the program had finished.

Conclusions

Cost outcomes were 20–30 times Zimbabwe's per capita GDP, and unlikely to be affordable
within government services. This analysis concludes that LIGs are not cost-effective
or affordable relative to other interventions for improving health and nutrition status
of PLHIV. Nonetheless, given the myriad benefits acquired by participant households,
such programs hold important potential to improve quality of life and reduce stigma
against PLHIV.